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Objectives Pleural effusion recognizes heterogeneous etiology and pathogenesis and requires invasive diagnostic procedures. Usually, after pleural fluid analysis, 30–50% of patients with malignant pleural effusion exhibit negative pleural cytology, and the sensitivity of image-guided pleural needle-aspiration biopsy ranges between 60% and 70%. With the aim of differentiating between benign (BPE) and malignant (MPE) pleural effusions, several tumor markers have been assayed in the pleural fluid and the majority of studies focus on pleural carcinoembryonic antigen (p-CEA). The aims of this study were to evaluate (i) the diagnostic accuracy of p-CEA of patients with pleural effusions undergoing video-assisted thoracoscopic surgery (VATS) for diagnostic purpose, (ii) the relationship between p-CEA and serum CEA (s-CEA), and (iii) the usefulness of the p-CEA/s-CEA ratio in the diagnosis of malignant pleural effusions (MPE). Design & methods We prospectively enrolled in the study 134 consecutive patients with pleural effusions, scheduled for having VATS and biopsy. The final diagnosis, based on histopathology of the VATS-guided specimens, was available for all patients. p-CEA and s-CEA was assayed with a chemiluminescence immunoassay method (CLIA), applied on the Maglumi 2000 Plus automated platform (SNIBE, Shenzen, China). Results The sensitivity and accuracy of p-CEA was significantly higher than that of pleural cytology at the same specificity comparing BPE with MPE and BPE with non-small lung cancer. The sensitivity of p-CEA and PC together reached 100% (BPE vs. NSCLC) and 91.5% (BPE vs. MPE excluding mesothelioma), respectively. Conclusions The p-CEA measurement in patients with pleural effusion of uncertain etiology is a safe and cost-effective procedure, everywhere easily available, which may help clinicians in selecting patients for further evaluations. An elevated p-CEA level in a patient with pleural effusion and negative pleural cytology suggests the need of more invasive procedure (e.g. VATS-guided biopsies), whilst low p-CEA may support a follow-up. [ABSTRACT FROM AUTHOR]

Spontaneous regression of hepatocellular carcinoma (HCC) is a rare event. Here we present a case of spontaneous regression of metastatic HCC. A 53-year-old man with hepatitis C and alcoholic cirrhosis was found to have a large liver mass consistent with HCC based on its radiographic features. Imaging also revealed left portal and hepatic vein thrombosis, as well as multiple lung nodules concerning for metastases. Approximately 2 months after the initial diagnosis, both the primary liver lesion and the lung metastases decreased in size and eventually resolved without any intervention. Thereafter, the left hepatic vein thrombus progressed into the inferior vena cava and the right atrium, and the patient died due to right heart failure. In this case report and literature review, we discuss the potential mechanisms for and review the literature on spontaneous regression of metastatic HCC. [ABSTRACT FROM AUTHOR]

A rare complication associated with the Hodgkin's lymphoma is the occurrence of persistent or recurrent hypoglycemia. Although few cases have been reported in the literature, describing its pathophysiology to be multifactorial, it is difficult to determine the exact cause. We present the case of a 26 year old patient diagnosed with Hodgkin's lymphoma who developed recurrent episodes of hypoglycemia and also discuss the various causes for its pathogenesis. In this case the serum insulin and C-peptide levels were found to be low, suggesting the presence of insulin like growth factors (IGF) secreted by the cancer cells. Also, we performed a18F-2-fluoro-2-deoxy-d-glucose positron emission tomography that showed a massive tumor load. The published reports in literature have similary suggested the presence of IGF or auto-antibodies secreted by the tumor cells and also the Warburg effect in patients with high tumor load. Further research is required to clearly diagnose and define the exact etiopathogenesis of the hypoglycemia occurring in a patient with Hodgkin's lymphoma. [ABSTRACT FROM AUTHOR]

Pediatric head and neck lymphedema is rare and there have not been any reported cases in children. Here we discuss severe, diffuse head and neck lymphedema in a child caused by compression of the internal jugular veins by lymphadenopathy from Kawasaki's disease. With steroid and intravenous immunoglobulin treatment, the lymphadenopathy improved and facial edema slowly resolved. In review of the literature, complications of head and neck lymphedema including airway obstruction and blindness are discussed. This case highlights the importance of the pediatric otolaryngologist considering lymphedema as a cause for facial swelling and monitoring for complications of lymphedema. [ABSTRACT FROM AUTHOR]

ObjectiveNeuroendocrine tumours (NETs) represent a heterogeneous group of neoplasms, which include functioning and non-functioning forms. Somatostatin analogues (SSAs) play a key role in the management of these tumours. Herein, we aimed at reviewing the current evidence about the role of SSAs in the treatment of gastro-entero-pancreatic (GEP)-NETs.Material and methodsAn extensive bibliographical search was performed in PubMed using the following keywords: gastro-entero-pancreatic neuroendocrine tumours, somatostatin analogues, octreotide, lanreotide, in order to identify all the pertinent English-written articles published between 1990 and 2015.ResultsSSAs have shown to help the symptomatic and biochemical improvement of patients with NETs and to exhibit a good safety profile. Recent studies have also reported a role for SSAs in tumour growth control, although the results are less impressive and the underlying mechanisms are not fully understood.ConclusionsSSAs are well known as a symptomatic and, to lesser extent, anti-proliferative treatment in GEP-NETs. However, some issues, including optimal dosage, benefits and adverse events of combination with other molecules, and the role of new analogues, remain to be elucidated in further randomised studies. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic Stress Disorder (PTSD) is a commonly occurring mental illness. There are multiple treatments for PTSD that have similar effectiveness, but these treatments differ substantially in other ways. It is desirable to have well-informed patients involved in treatment choices. A patient decision aid (PtDA) is one method to achieve this goal. This manuscript describes the rationale and development of a patient decision aid (PtDA) designed for patients with PTSD. Methods: We conducted an informational needs assessment of veterans (n = 19) to obtain their baseline information needs prior to the development of the PtDA. We also conducted a literature review of effective PTSD treatments, and we calculated respective effective sizes. A PtDA prototype was developed according to the guidelines from the International Patient Decision Aid Standards. These standards guided our development of both content and format for the PtDA. In accordance with the standards, we gathered feedback from patients (n = 20) and providers (n = 7) to further refine the PtDA. The information obtained from patients and the literature review was used to develop a decision aid for patients with PTSD. Results: Patients with PTSD reported a strong preference to receive information about treatment options. They expressed interest in also learning about PTSD symptoms. The patients preferred information presented in a booklet format. From our literature review several treatments emerged as effective for PTSD: Cognitive Therapy, Exposure Therapy, Eye Movement Desensitization Therapy, Selective Serotonin Reuptake Inhibitors, venlafaxine, and risperidone. Conclusion: It appears that the criteria set forth to develop decision aids can effectively be applied to PTSD. The resultant PTSD patient decision aid is a booklet that describes the causes, symptoms, and treatments for PTSD. Future work will examine the effects of use of the PTSD decision aid in clinical practice. [ABSTRACT FROM AUTHOR]

Encephalitis is a complex neurological disease that is associated with significant morbidity and mortality, and the etiology of the disease is often not identified. Human metapneumovirus (hMPV) is a common cause of upper and lower respiratory tract infections in children. Few reports are available showing possible involvement of hMPV in development of neurologic complications. Here, we describe an infant, the youngest case in literature, with refractory status epilepticus and severe encephalitis in whom hMPV was detected in respiratory samples and review diagnostic workup of patient with encephalitis. [ABSTRACT FROM AUTHOR]

The aim of this literature review was to identify breastfeeding practices that support women with diabetes to breastfeed. A search was undertaken of CINAHL and Medline databases to identify studies that inform breastfeeding practice for women with diabetes. This resulted in 14 studies (19 records). Most studies focused on women with GDM and T1D with some consideration of T2D. The review has been organised using Maslow's Hierarchy of Needs, to enable a clear focus on the needs of women while identifying supportive practices. The key findings of this review are that breastfeeding as the first feed and exclusive breastfeeding are beneficial to meeting physiological needs. Preparations such as having food nearby and having someone to call on can help meet the woman's safety and security needs. A sense of love and belonging is supported by the practice of an early first breastfeed, but antenatal breast milk expression is currently not recommended. The woman's self-esteem can be enhanced through informed multidisciplinary support. Finally, self-actualisation or success with breastfeeding has been achieved by women with diabetes. Common breastfeeding concerns rather than diabetes have been identified as reasons for cessation of breastfeeding. Practices that support women deal with these concerns are recommended. [ABSTRACT FROM AUTHOR]

Summary Taxane induced neuropathy (TIN) is the most limiting side effect of taxane based chemotherapy, relative to the majority of breast cancer patients undergoing therapy with both docetaxel and paclitaxel. The symptoms begin symmetrically from the toes, because the tips of the longest nerves are affected for first. The patients report sensory symptoms such as paresthesia, dysesthesia, numbness, electric shock-like sensation, motor impairment and neuropathic pain. There is a great inter-individual variability among breast cancer women treated with taxanes, in fact 20–30% of them don’t develop neurotoxicity. Actually, there is no standard therapy for TIN, although many medications, antioxidants and natural substances have been tested in vitro and in vivo. We will summarize all most recent literature data on TIN prevention and treatment, in order to reach an improvement in TIN management. Further studies are needed to evaluate new therapies that restore neuronal function and improve life quality of patients. [ABSTRACT FROM AUTHOR]

Occlusion of the intracranial internal carotid artery (ICA) by a pituitary adenoma with resulting cerebral ischemia is a very rare but devastating occurrence. The authors present a case in which a condition of symptomatic ICA occlusion due to a giant pituitary adenoma was successfully treated using a preliminary extraintracranial bypass as a “bridge” to the tumor removal. A 52-year-old patient presented with a minor stroke followed by pressure-dependent transient ischemic attacks consistent with a condition of hypoperfusion. MR imaging and a digital subtraction angiography revealed a pituitary adenoma occluding the ICA on the right side. He underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass with the aim of revascularizing the ischemic hemisphere and reducing the risk of perioperative stroke or stroke evolution. The patient was subsequently operated on to remove the adenoma through a transsphenoidal approach. The postoperative course was uneventful and the patient has suffered no further ischemic events. When there are no emergency indications to decompress the optical pathways but the patient is at risk of impending stroke because of ICA occlusion, a two-step strategy consisting of a bypass and subsequent removal of the pituitary adenoma may be a valuable option. [ABSTRACT FROM AUTHOR]

Background Trigeminal neuralgia typically occurs in the middle-aged to elderly population, is believed to be related to abnormal conduction within the trigeminal nerve, and is possibly is attributable to changes in myelin induced by pulsatile mechanical trauma from an adjacent vessel. At the point just before it enters the brainstem, there is a short segment at which nerve axons are still ensheathed in central myelin (produced by oligodendrocytes), but after a few millimeters, there is a transition to peripheral myelin (produced by Schwann cells). The region of this transition is called the Obersteiner-Redlich zone. It is thought that the area of the nerve containing the central form of myelin is especially susceptible to pathologic changes from vascular contact that result in demyelination and altered conduction. When associated with a venous angioma at the root entry zone, trigeminal neuralgia usually presents at a younger age. Methods We report a 34-year-old man with a complaint of left hemifacial stabbing pain in maxillomandibular area that was triggered by chewing and speaking. On examination, no neurologic deficit was detected. The pain was not relieved significantly, even with the administration of carbamazepine . Magnetic resonance imaging demonstrated venous angioma in the left cerebello-pontine region. Results Microvascular decompression was performed uneventfully. The patient's pain was completely relieved without neurologic deficits. Conclusion It seems that the trigeminal neuralgia caused by venous angioma may occur in the younger population. In most cases, the vessel that caused compression can be identified with magnetic resonance imaging without the need for intensive conventional angiography. [ABSTRACT FROM AUTHOR]

Epidermolysis Bullosa is a congenital, genetic, vesiculobullous disease. It may be autosomal dominant and recessively inherited. The major types of Epidermolysis Bullosa are Epidermolysis Bullosa Simplex, Junctional Epidermolysis Bullosa, and Dystrophic Epidermolysis Bullosa. Due to the systemic disorders specific to the Epidermolysis Bullosa patient, approach to dental care has gain importance in these cases. This article presents improving of patient comfort with oral health maintenance and atraumatic dental interventions in three cases diagnosed with Epidermolysis Bullosa and reviews the literature regarding clinical applications in brief. Three patients - one with Epidermolysis Bullosa Simplex and two with Dystrophic Epidermolysis Bullosa - were referred to our clinic by other medical institutions because of discomfort due to dental complaints. Intra and extra oral symptoms were examined and treatment plans were arranged for each one of them. Dental treatment was carried out mainly by means of establishing non-invasive methods like oral hygiene motivation along with professional debridement and radical methods like tooth extraction. All the treatments were done with precision by experienced specialists in the field of dentistry. Treated successfully the patients were taken under control for regular observation of the disease's oral symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Degenerative spondylosis and kyphoscoliosis are increasingly recognized entities in patients with Parkinson's disease. Surgical treatment with spinal fusion can be complicated due to poor bone quality and muscular dysfunction in this patient population. The goal of this paper is to investigate surgical outcomes in Parkinson's patients undergoing spine surgery. Methods: We performed a literature review using the PubMed and Google Scholar search engines investigating "Parkinson's disease and spinal fusion surgery" from the period of 2000 to 2013. The inclusion criteria included only English articles with Parkinson's patients that underwent spinal surgery. We identified and reviewed all six articles that included ninety-five patients with Parkinson's disease who underwent spinal surgery. Results: A total of 95 patients with Parkinson's disease who underwent spinal fusion surgery were reviewed with average patient age of 69 and a 3:4 male to female ratio. With an average follow up of 40 months, 46 out of 73 patients (63%) were judged to have satisfactory outcomes with poor outcomes noted in the remaining 37%. These included but were not limited to pseudoarthrosis, hardware failure/pullout, development of adjacent level disease, persistent kyphosis or sagittal imbalance, and no improvement or worsening in their postoperative visual analog pain scale. There was a 45% (29/65) revision rate and a 59% (30/51) complication rate following the index procedure. Conclusion: It remains unclear whether Parkinson's patients benefit from spinal fusion surgery. Further prospective research is warranted to investigate surgical outcomes in this subset of patients. [ABSTRACT FROM AUTHOR]

Emerging heart failure (HF) concepts in the growing population of adults with congenital heart disease (ACHD) are reviewed in the following article with a focus on individuals with tetralogy of Fallot (TOF), the largest group of adults with repaired cyanotic congenital heart disease (CHD). In the first section, the changing epidemiology of CHD and HF in ACHD patients is described. We demonstrate the challenges health care providers face when caring for this unique population. Emphasis is placed on the importance and difficulty of identifying patients at risk for HF, of which TOF patients comprise a substantial subset, underscoring the benefits of specialized cardiac care. In the second portion of the article, we review underlying mechanisms of HF in adults with TOF. We elaborate on the wide-ranging etiologies of HF that reflect a confluence of factors related to native anatomic substrate, history of surgical intervention(s), and superimposed hemodynamic and/or ischemic burden to the right and left heart. We describe state-of-the-art imaging concepts as they apply to qualifying and quantifying acquired myocardial and valvular dysfunction in adults with repaired TOF. In the final part of the article, we review the current literature pertaining to the management of adults with repaired TOF. Specifically, we explore medical and surgical issues related to pulmonary valve replacement, arrhythmia management, and transplantation. Finally, we highlight current knowledge gaps and propose future directions of much-needed research that will improve the quality of care for this growing population. [ABSTRACT FROM AUTHOR]

Postoperative visual loss from any cause is potentially catastrophic. We present a case of Valsalva hemorrhagic retinopathy (VHR) as a rare cause of impaired vision after an apparently uneventful general anesthetic. Previously published cases of VHR, anesthetic related and otherwise, are reviewed and the phenomenon discussed. Although VHR is considered to be rare, the events and activities with which it is associated are relatively common, both in everyday life and in the operating room. We suggest that the occurrence of VHR after anesthesia and surgery may be more frequent than previously appreciated and make recommendations for further investigations. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI; direct self-injury without lethal intent) often is thought to be associated with impulse control problems. Recent research, however, offers conflicting results about whether impulsivity is a risk factor for NSSI engagement. To disentangle findings on the link between impulsivity and NSSI, an extensive review of the literature was conducted using several electronic databases (i.e., PsychInfo, PsychArticles, ERIC, CINAHL, and MEDLINE). In total, 27 studies that met the specific inclusion criteria were identified. Results of a meta-analysis revealed that individuals who engaged in NSSI self-reported greater impulsivity than individuals who did not engage in NSSI, and that this effect was most consistent for measures of negative urgency. In contrast, there was little evidence of an association between lab-based measures of impulsivity (e.g., Go/No-Go, Stop/Signal Task) and NSSI. Moreover, the link between impulsivity and NSSI found for self-report measures was sometimes eliminated when other risk factors for NSSI were controlled (e.g., abuse, depression, post-traumatic stress disorder). In addition to integrating findings, the present review provides several explanations for the discrepancies in findings between studies employing self-report versus lab-based measures of impulsivity. To conclude, several specific recommendations for future research directions to extend the literature on impulsivity and NSSI are offered. [ABSTRACT FROM AUTHOR]

Summary Epstein-Barr Virus (EBV) infection can lead to infectious mononucleosis syndrome with the typical symptoms of fever, pharyngitis, and lymphadenopathy. Self-limited mild to moderate elevation of liver enzymes and hepatosplenomegaly are common. However, cholecystitis is not usually considered part of a primary EBV infection and ultrasound scan (USS) of the liver and gallbladder is not routinely performed. Acute acalculous cholecystitis (AAC) caused by etiologies other than primary EBV infection is often associated with severe illness and antibiotic treatment and surgery may be needed. We present a case with primary EBV infection and AAC and a literature review. Our patient was a 34-year-old woman with clinical, biochemical and serological signs of primary EBV infection (lymphocytes 7.6 × 10˄9/l, monocytes 2.6 × 10˄9/l, positive early antigen IgM test and 14 days later positive early antigen IgG test). During admission, increasing liver function tests indicated cholestasis (alanine aminotransferase 61 U/l, alkaline phosphatase 429 U/l and bilirubin 42 μmol/l). USS revealed a thickened gallbladder wall indicating cholecystitis but no calculus. All other microbiological tests were negative. The literature search identified 26 cases with AAC and acute EBV infection; 25 cases involved females. Sore throat was not predominant (six reported this), and all cases experienced gastrointestinal symptoms. Our and previous published cases were not severely ill and recovered without surgical drainage. In conclusion primary EBV infection should be considered in cases of AAC, especially in young women. In cases associated with EBV infection neither administration of antibiotics nor surgical drainage may be indicated. [ABSTRACT FROM AUTHOR]

The clear cell/lipid-rich change has been described in neuroendocine tumors in several organs, but rarely observed in the appendix. In this study, we describe the morphologic, immunohistochemical features of incidentally discovered appendiceal carcinoids entirely represented by clear cells in a 22-year-old man and a 52-year-old woman. Ultrastructual examination demonstrated abundant lipid droplets and dense core granules. The mechanism leading to lipid accumulation in the cytoplasm has not been discovered, but degenerative processes following recurrent inflammatory change might be considered. This uncommon variant of appendiceal classic carcinoid tumors may bear a superficial resemblance to goblet carcinoid and/or appendiceal metastases from clear cell carcinoma. Awareness of clear cell carcinoid of the appendix will prevent incorrect diagnosis and unnecessary aggressive management. [ABSTRACT FROM AUTHOR]

Xp21 continuous gene deletion syndrome is characterized by complex glycerol kinase deficiency ( GK ), adrenal hypoplasia congenital ( NROB1 ), intellectual disability and/or Duchenne muscular dystrophy ( DMD ). The clinical features depend on the size of the deletion, as well as on the number and the nature of the encompassed genes. More than 100 male patients have been reported so far, while only a few cases of symptomatic female carriers have been described. We report here detailed clinical features and X chromosome inactivation analysis in two unrelated female patients with overlapping Xp21 deletions presenting with intellectual disability and inconstant muscular symptoms. [ABSTRACT FROM AUTHOR]

Objective: They were assessed the experience with Schneiderian papillomas of the nasal and paranasal sinuses and their treatment results. Material and Method: A retrospective chart review of 37 patients presenting with Schneiderian papillomas of the nasal and paranasal sinuses was performed from January 2000 to April 2012. Patients' charts were reviewed for age, extent of tumor, location(s), computed tomography, magnetic resonance imaging, surgical technique, histopathological diagnosis and follow-up. Results: The most common symptom was unilateral nasal obstruction in 75.7% of cases, followed by epistaxis in 32.4%. The most common location was the maxillary sinus, followed by the ethmoid sinus and nasal cavity. Tumors were classified with the Krouse staging system at the time of diagnosis as follows: Tl, 12 patients (32%); T2, 17 (46%); T3, 7 (19%); and T4, 1 (3%). A total of 23 (62.17%) patients underwent endoscopic nasal surgery, 8 (21.63%) underwent a combined approach, 2 (5.40%) had lateral rhinotomy and external medial maxillectomy, and 4 (10.80%) were treated using only the Caldwell-Luc approach. Pathological assessment revealed 27 (72.97%) inverted papillomas, 7 (18.91%) fungiform papillomas, and 3 (8.10%) oncocytic Schneiderian papillomas. Among the 37 cases, only 3 patients with inverted papillomas were found to have recurrence, and were treated with open and endoscopic approaches. Conclusion: Oncocytic Schneiderian papilloma is uncommon compared to inverted and fungiform papilloma. Complete removal of the lesion is required. Close long-term follow-up is necessary for early recurrence and to allow for surgical salvage. [ABSTRACT FROM AUTHOR]

There is growing evidence that chronic pain conditions can have an associated central pathology, involving both cortical reorganisation and an incongruence between expected and actual sensory–motor feedback. While such findings are primarily driven by the recent proliferation of neuroimaging studies, the psychophysical tasks that complement those investigations have received little attention. In this review, we discuss the literature that involves the subjective appraisal of body representation in patients with chronic pain. We do so by examining three broad sensory systems that form the foundations of the sense of physical self in patients with common chronic pain disorders: (i) reweighting of proprioceptive information; (ii) altered sensitivity to exteroceptive stimuli; and, (iii) disturbed interoceptive awareness of the state of the body. Such findings present compelling evidence for a multisensory and multimodal approach to therapies for chronic pain disorders. [ABSTRACT FROM AUTHOR]

This focussed narrative review examines neurobiological and psychophysiological evidence supporting a role for altered reward processes in the development and maintenance of anorexia nervosa (AN). In AN, there does not appear to be a generalised inability to experience reward. Rather, data suggest that a reluctance to gain weight leads to an aversive appraisal of food- and taste-related stimuli. As a result, cues compatible with this aberrant mode of thinking become rewarding for the individual. Evidence also suggests that attribution of motivational salience to such cues promotes anorectic behaviours. These findings are consistent with models in which interactions between cognition and reward are important in eliciting the anorectic “habit”. A model is proposed which is consistent with elements of other theoretical frameworks, but differs in that its emphasis is towards neural overlaps between AN and addiction. It is consistent with AN being a reward-based learned behaviour in which aberrant cognitions related to eating and shape alter functioning of central reward systems. It proposes that the primary neural problem responsible for the development, maintenance, and treatment resistance is centred in the striatal reward system. This helps shift the emphasis of aetiological models towards reward processing, particularly in the context of illness-compatible cues. Furthermore, it suggests that continuing to explore the utility and valued nature of AN in the patient's life would be a useful inclusion in treatment and prevention models. [ABSTRACT FROM AUTHOR]

Background: Involvement of orbital structures by immunoglobulin G4-related disease (IgG4-RD) is not uncommon. We conducted this study to evaluate the clinicopathologic features of orbital IgG4-RD. Material/Methods: This was a retrospective, clinicopathologic study. Clinical records, light microscopic features, results of immunostaining with IgG & IgG4 and laboratory findings were reviewed in 16 patients diagnosed with orbital IgG4-RD. Results: Eleven patients had a bilateral disease, and the lacrimal gland was involved in 14. Dense sclerosis, plasma cell aggregates and dense lymphoplasmacytic infiltrate were seen in all patients. Serum IgG4 titre was elevated in 12 patients. Nine patients responded completely to glucocorticoid treatment. Five patients had a relapse on discontinuation of treatment. Conclusion: Orbital IgG4-RD is a distinct clinicopathologic entity requiring increased awareness and needs to be differentiated from other orbital lymphoproliferative lesions. [ABSTRACT FROM AUTHOR]

Wedescribe howthe combination of imaging and histologic findingswas essential in establishing a preoperative diagnosis of an extremely rare malignant granular cell tumor (GrCT) occurring in the lower extremity of a 17-year-old man. Magnetic resonance imaging demonstrated a large infiltrative tumor of heterogeneous intermediate signal intensity on both T1- and T2-weighted sequences. Subsequent computed tomography (CT) and fluorodeoxyglucose positron emission tomography CT scans of the patient revealed distant nodal and skeletal metastases. [ABSTRACT FROM AUTHOR]

Pulmonary infections caused by Aspergillus and Nocardia are commonly seen in immunocompromised patients, and accurate and timely diagnosis is important for proper therapeutic management to ensure favorable patient outcomes. Concomitant Aspergillus and Nocardia pulmonary infections are rare but have been reported in immunosuppressed patients who had organ transplants, chronic graft-versus-host disease, or chronic granulomatous disease. This article describes a very rare case of Aspergillus and Nocardia co-infection in a patient on long-term steroid therapy and reviews the clinical and epidemiologic characteristics associated with both opportunistic pathogens. [ABSTRACT FROM AUTHOR]

We report two cases of non-smoker patients diagnosed with EGFR-mutated lung adenocarcinoma and bearing germinal TP53 gene mutation, also known as Li-Fraumeni syndrome (LFS). We describe for the first time an EGFR -TKI resistance mutation in this population. Finally, we provide an analysis of discerning epidemiological data obtained from the IARC database and from all the published cases of EGFR -mutated lung cancer in TP53 germline mutation carriers. [ABSTRACT FROM AUTHOR]

Recent research in systemic lupus erythematosus (SLE) yielded new antigens and antibodies in SLE patients. We describe the various autoantibodies that can be detected in patients with SLE. A literature review, using the terms “autoantibody” and “systemic lupus erythematosus”, was conducted to search for articles on autoantibodies in SLE, their target antigens, association with disease activity and other clinical manifestations. One hundred and eighty autoantibodies were so far described in SLE patients. These include autoantibodies that target nuclear antigens, cytoplasmic antigens, cell membrane antigens, phospholipid-associated antigens, blood cells, endothelial cells, and nervous system antigens, plasma proteins, matrix proteins, and miscellaneous antigens. The target of an autoantibody, the autoantigen properties, autoantibody frequencies in SLE, as well as clinical associations, and correlation with disease activity are described for all 180 autoantibodies. SLE is so far the autoimmune disease with the largest number of detectable autoantibodies. Their production could be antigen-driven, the result of a polyclonal B cell activation, impaired apoptotic pathways, or the outcome of an idiotypic network dysregulation. [ABSTRACT FROM AUTHOR]

Introduction Knowledge about the functional consequences of lower limb long bone fractures is helpful to inform patients, clinicians and employers about their recovery process and prognosis. This study aims to describe the epidemiology and health outcomes of femoral and tibial shaft fractures treated at two level I trauma centres, by comparing the differences between patients with delayed union or nonunion and patients with union. Patients and methods An analysis of registry data over two years, supplemented with medical record review, was conducted. Fracture healing was retrospectively assessed by clinical and radiological evidence of union, and the need for surgical intervention. SF-12 scores, and work and pain status were prospectively recorded at six and twelve months post injury. Results 285 fractures progressed to union and 138 fractures developed delayed union or nonunion. There was a significant difference between the two cohorts with regards to the mechanism of injury, association with multi-trauma, open fractures, grade of Gustilo classification, patient fund source, smoking status and presence of comorbidities. The SF-12 physical component score was less than 50 at both six and twelve months with improvement in the union group, but not in the delayed union or nonunion group. 72% of patients with union had returned to work at one year, but 54% continued to have pain. The difference compared to patients with delayed union or nonunion was significant. Discussion Even patients whose fractures unite in the expectant time-frame will have residual physical disability. Patients with delayed union or nonunion have still poorer outcomes, including ongoing problems with returning to work and pain. It is important to educate patients about their injury so that they have realistic expectations. This is particularly relevant given that the patients most likely to sustain femoral or tibial shaft fractures are working-age healthy adults, and up to a third of fractures may develop delayed union or nonunion. Conclusion Despite modern treatment, the patient-reported outcomes of lower limb long bone shaft fractures do not return to normal at one year. Patients with delayed union or nonunion can expect poorer outcomes. [ABSTRACT FROM AUTHOR]

Teriparatide is a skeletal anabolic treatment for patients with osteoporosis at high risk for fracture. Because adequate clinical trials have not yet been conducted to assess the efficacy of teriparatide for reducing the risk of hip fracture, we review here the literature regarding how treatment with teriparatide affects the hip in patients with osteoporosis. Teriparatide increases cancellous bone volume, improves bone architecture, and - uniquely among osteoporosis treatments - increases cortical thickness and cortical porosity. By bone scan and positron emission tomography, teriparatide increases bone formation throughout the skeleton, including the hip. Consistent with these findings, studies using dual-energy X-ray absorptiometry and quantitative computed tomography for longitudinal assessment of changes at the hip have consistently shown increases in areal and volumetric bone mineral density, cortical thickness, and finite element-estimated hip strength in patients treated with teriparatide. Finally, in clinical fracture-outcome trials, treatment with teriparatide has been shown to reduce the risk of nonvertebral fracture, a composite endpoint that includes hip fracture. Taken together, this body of evidence suggests that teriparatide positively affects the hip in patients with osteoporosis. [ABSTRACT FROM AUTHOR]

Background/Purpose Thymectomy may benefit patients with generalized myasthenia gravis (MG) or myasthenia with thymomas. Currently, video-assisted (VA) thoracic surgery is popular and plays an important role in thymectomy. We compared the clinical outcomes of VA thymectomy with conventional transsternal (TS) approach to investigate the effectiveness of VA technology in the current era. Methods A retrospective review of our thymectomy results for patients with MG from 1998 to 2011 was conducted. A total of 83 consecutive patients were enrolled. According to the surgeons’ and patients’ preference, 39 patients received conventional TS thymectomy and 44 were operated on in a VA fashion. The results were categorized and analyzed according to the Myasthenia Gravis Foundation of America (MGFA) postintervention statuses with some modification. Results No obvious difference between conventional TS thymectomy and VA thymectomy was noted regarding the remission statuses and the clinical outcomes by the modified MGFA score. However, the patients who received VA thymectomy showed shorter intensive care unit (ICU) stays (4.2 ± 3.3 days vs. 2.3 ± 1.5 days, p = 0.001). Conclusion Compared with the conventional TS thymectomy, the VA approach is similarly effective with shorter ICU stays. [ABSTRACT FROM AUTHOR]

Introduction A pneumopericardium presenting after penetrating chest trauma is a rare event. The surgical management of this clinical problem has not been clearly defined. The aim of this study was to document the mode of presentation and to suggest a protocol for management. Patient and methods A review of a prospectively collected cardiac database of patients presenting to Groote Schuur Hospital Trauma Centre between October 2001 and February 2009 with a pneumopericardium on chest X-ray after penetrating trauma. Results There were 27 patients with a pneumopericardium (mean age 25 years, range 17-36). The mechanism of injury was a stab wound to the chest in 26 patients and a single patient with multiple low velocity gunshot wounds. Six patients (22%) were unstable and required emergency surgery. One of these patients presented with a tension pneumopericardium. Twenty-one patients were initially stable. Two of these (10%) patients later developed a tension pneumopericardium within 24-h and were taken to theatre. The remaining 19 patients were managed with a subxiphoid pericardial window (SPW) at between 24 and 48 h post admission. Ten of these 19 patients (52%) were positive for a haemopericardium. Only 4 of the 19 underwent a sternotomy and only two of these had cardiac injuries that had sealed. There were no deaths in this series. Conclusion Patients with a penetrating chest injury with a pneumopericardium who are unstable require emergency surgery. A delayed tension pneumopericardium developed in 10% of patients who were initially stable. It is our recommendation that all stable patients with a pneumopericardium after penetrating chest trauma should undergo a SPW. A sternotomy is not required in stable patients. [ABSTRACT FROM AUTHOR]

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome. [ABSTRACT FROM AUTHOR]

Study Design: It is a case series involving clinical presentation, radiological findings, surgical technique and long term outcome of Non-dysraphic intramedullary spinal cord lipomas in adults along with the review of the literature. Purpose: The purpose of the study is to find out from our series as well as from literature what determines the long term outcome and how it can be improved in patients diagnosed to have intramedullary spinal cord lipomas. Overview of Literature: Non-dysraphic spinal intramedullary lipomas in adults are extremely rare. Majority of cases occur in children and in cervico-dorsal regions. Only eight cases of dorso-lumbar spinal lipomas without spinal dysraphism in adults have been reported in the English literature till 2013. Methods: Here we report our experience with three such cases in the dorsolumbar region and discuss the surgical technique and the long term outcome of such cases. Results: Review of literature and from our own cases we conclude that long term outcome after surgery is determined by the preoperative neurological status. Conclusions: Earlier surgical intervention with preserved neurological status results in better outcome. Radical subtotal excision without producing iatrogenic postoperative neurological deficit should be the goal of the surgery and it stabilizes the disease process in the long run. When early clinico-radiological signs of recurrence develop, such patient's to be reoperated immediately to prevent them from developing a fixed neurological deficit. [ABSTRACT FROM AUTHOR]

Background: Variability in patient-reported outcomes of psychological treatments has been partly attributed to therapists – a phenomenon commonly known as therapist effects. Meta-analytic reviews reveal wide variation in therapist-attributable variability in psychotherapy outcomes, with most studies reporting therapist effects in the region of 5% to 10% and some finding minimal to no therapist effects. However, all except one study to date have been conducted in high-intensity or mixed intervention groups; therefore, there is scarcity of evidence on therapist effects in brief low-intensity psychological interventions. Objective: To examine therapist effects in low-intensity interventions for depression and anxiety in a naturalistic setting. Data and Analysis: Session-by-session data on patient-reported outcome measures were available for a cohort of 1,376 primary care psychotherapy patients treated by 38 therapists. Outcome measures included PHQ-9 (sensitive to depression) and GAD-7 (sensitive to general anxiety disorder) measures. Three-level hierarchical linear modelling was employed to estimate therapist-attributable proportion of variance in clinical outcomes. Therapist effects were evaluated using the intra-cluster correlation coefficient (ICC) and Bayesian empirical predictions of therapist random effects. Three sensitivity analyses were conducted: 1) using both treatment completers and non-completers; 2) a sub-sample of cases with baseline scores above the conventional clinical thresholds for PHQ-9 and GAD-7; and 3) a two-level model (using patient-level pre- and post-treatment scores nested within therapists). Results: The ICC estimates for all outcome measures were very small, ranging between 0% and 1.3%, although most were statistically significant. The Bayesian empirical predictions showed that therapist random effects were not statistically significantly different from each other. Between patient variability explained most of the variance in outcomes. Conclusion: Consistent with the only other study to date in low intensity interventions, evidence was found to suggest minimal to no therapist effects in patient-reported outcomes. This draws attention to the more prominent source of variability which is found at the between-patient level. [ABSTRACT FROM AUTHOR]

Background Isolated replacement of the tricuspid valve is rare, and the decision to operate is difficult. This study reviews the in-hospital mortality and long-term survival after tricuspid valve replacement in the absence of concomitant left sided valve surgery. It identifies predictors of poor outcome. Methods All patients who underwent tricuspid valve replacement between January 1995 and December 2011 were retrospectively reviewed. Patients having concomitant mitral or aortic valve surgery were excluded. Logistic regression was used to identify predictors of early and late death. Results Twenty-nine cases were identified. There were six in-hospital deaths (20.6%), and eight late deaths. Ascites was associated with in-hospital death (hazard ratio 16.96; p=0.0052). Higher dose of Frusemide was associated with late mortality (hazard ratio 1.157 per 20mg increase; p=0.0155). Frusemide dose and ascites were both significantly associated with death overall (p<0.01). Survival analysis estimated a 50% probability of surviving to 12.45 years. Conclusions Isolated tricuspid valve replacement has a high peri-operative risk. Long-term survival in this study was consistent with other reports. Ascites and higher doses of Frusemide were associated with poor outcomes. [ABSTRACT FROM AUTHOR]

Backgrounds The purpose of this study was to investigate the relationship between the level of tobacco smoking and the clinicopathological features of non-small cell lung cancer (NSCLC) patients, individually for adenocarcinoma (Ad) and squamous cell carcinoma (Sq). Patients and methods We retrospectively reviewed the clinical records of 1825 consecutive lung cancer patients who underwent surgery in our department. Among these, the data sets of 750 Ad patients and 364 Sq patients who received lobectomy or more extensive resection were available. Results In Ad patients, those who had never smoked (never-smokers) (n=309) were more likely to be female, to have less advanced stage tumors, and to have a significantly better prognosis than those who had ever smoked (ever-smokers) (n=441) (5-year OS: never-smokers, 67.9%; ever-smokers, 53.7%, p<0.0001). In Sq patients, the never-smokers (n=15) were more likely to be female than the ever-smokers (n=349). Among ever-smokers, the light-smokers (PY≤30; n=56) were associated with more female patients, more advanced stage tumors, and significantly worse prognoses than were the heavy smokers (PY>30; n=292) (p=0.0003). The multivariate survival analysis showed that light smoking was related to a worse prognosis compared with heavy smoking (HR=2.06, 95% CI 1.43-2.98, p=0.0001). Conclusions The never-smokers had a significantly better prognosis than ever-smokers among Ad patients, whereas the light-smokers had a significantly worse prognosis than heavy smokers among Sq patients. There may be factors other than tobacco carcinogens that influence the development of Sq in never and/or light smokers. [ABSTRACT FROM AUTHOR]

Objective To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems. Methods We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions. Results We identified 65 patients from these clinics with SB. The mean age was 30.6 years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17 months and 12 months, respectively (range 1 month-10 years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems. Conclusion On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems. [ABSTRACT FROM AUTHOR]

Objective To determine the relationship between obesity and febrile urinary tract infection (UTI) in young children. Methods We reviewed all medical records of children aged <3 years who visited our institution for febrile UTIs and infant national health checkups (controls) between January 2008 and February 2012. All subjects were subcategorized into 3 groups of lean, overweight, and obese using weight-for-length measurements. The effect of obesity on UTI risk was evaluated and odds ratios were calculated. Results We analyzed 465 patients with UTIs and 812 controls. The proportion of overweight and obese children was higher in patients with UTIs (22.8%) and acute pyelonephritis (APN; 31.1%) compared with those in the control (11.7%; P <.05). After adjusting for age and gender, the odds ratio (OR) of UTI in obese relative to lean children was 1.84 (95% confidence interval [CI], 1.11-3.05) and that of APN was 2.43 (95% CI, 1.27-4.62). The OR of APN in overweight relative to lean children was 1.96 (95% CI, 1.11-3.46). After adjusting for age, the OR of APN in obese relative to lean boys was 2.74 (95% CI, 1.11-6.77) and that in overweight to lean girls was 2.48 (95% CI, 1.05-5.83). Within patients with UTIs, compared with lean children, the obese showed a longer duration of fever and a higher frequency of APN and the overweight had a higher incidence of hydronephrosis (P <.05). Conclusion Obesity may be associated with higher odds of a febrile UTI and APN in young children. [ABSTRACT FROM AUTHOR]

Abstract: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with an adult onset characterized by loss of both upper and lower motor neurons. In ~10% of cases, patients developed ALS with an apparent genetic linkage (familial ALS or fALS). Approximately 20% of fALS displays mutations in the SOD1 gene encoding superoxide dismutase 1. There are many proposed cellular and molecular mechanisms among which, mitochondrial dysfunctions occur early, prior to symptoms occurrence. In this review, we modeled the effect of mutant SOD1 protein via the formation of a toxic complex with Bcl2 on mitochondrial bioenergetics. Furthermore, we discuss that the shutdown of ATP permeation through mitochondrial outer membrane could lead to both respiration inhibition and temporary mitochondrial hyperpolarization. Moreover, we reviewed mitochondrial calcium signaling, oxidative stress, fission and fusion, autophagy and apoptosis in mutant SOD1-linked ALS. Functional defects in mitochondria appear early before symptoms are manifested in ALS. Therefore, mitochondrial dysfunction is a promising therapeutic target in ALS. This article is part of a Special Issue entitled: Misfolded Proteins, Mitochondrial Dysfunction, and Neurodegenerative Diseases. [Copyright &y& Elsevier]

Although prognosis of lupus nephritis has improved over time, a substantial amount of lupus patients still reach end-stage renal disease and require dialysis. Treatment of these patients can be challenging, since the disease poses a number of problems that can portend a poor prognosis, such as infections, lupus reactivations, vascular access thrombosis and cardiovascular complications. Consensus is lacking among investigators about the real incidence of these complications and related diagnosis and treatment. Moreover, the choice of the type of dialysis treatment and the overall prognosis are still a matter of debate. In this paper, we have reviewed the currently available literature in an attempt to answer the most controversial issues about the topic. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: The objective of this study was to delineate the frequency of delayed diagnosis in cases of subacute thyroiditis (SAT) and intervals between onset of clinical symptoms and appearance of abnormal laboratory findings. Methods: We reviewed the medical records of 27 patients (7 men and 20 women) with SAT who visited our hospital between 2007 and 2013. Results: On presentation to the hospital, 5 of 27 SAT cases (18.5%) showed normal laboratory findings. Among these 5 cases, the mean interval between symptom onset and thyrotropin (TSH) suppression was 6.3 weeks, and the mean interval to elevation of fT4 was 6.7 weeks. The longest interval from symptom onset to appearance of an abnormal laboratory finding was 11 weeks. Conclusion: Sometimes time-lag exists between onset of clinical symptoms and the appearance of abnormal laboratory findings in patients with SAT. The possibility of this disease should not be excluded from the differential diagnoses for patients with clinical symptoms consistent with SAT but showing normal laboratory findings. [Copyright &y& Elsevier]

Background Endocannabinoid system is involved in the regulation of the brain-immune axis. Cannabis consumption is related with the development, course, and severity of psychosis. The epidemiological evidence for increased occurrence of immunological alterations in patients with psychosis has not been sufficiently addressed. The aim of this review is to establish whether there is any scientific evidence of the influence of cannabinoids on aspects of immunity that affect susceptibility to psychotic disorder induction. Methods A comprehensive search of PubMed/MEDLINE, EMBASE and ISI Web of Knowledge was performed using combinations of key terms distributed into three blocks: "immune", "cannabinoid", and "endocannabinoid receptor". Studies were considered to be eligible for the review if they were original articles, they reported a quantitative or qualitative relation between cannabinoid ligands, their receptors, and immune system, and they were carried out in vitro or in mammals, included humans. All the information was systematically extracted and evaluated. Results We identified 122 articles from 446 references. Overall, endocannabinoids enhanced immune response, whereas exogenous cannabinoids had immunosuppressant effects. A general change in the immune response from Th1 to Th2 was also demonstrated for cannabinoid action. Endogenous and synthetic cannabinoids also modulated microglia function and neurotransmitter secretion. Conclusion The actions of cannabinoids through the immune system are quite regular and predictable in the peripheral but remain fuzzy in the central nervous system. Despite this uncertainty, it may be hypothesized that exposure to exocannabinoids, in particular during adolescence might prompt immunological dysfunctions that potentially cause a latent vulnerability to psychosis. Further investigations are warranted to clarify the relationship between the immunological effects of cannabis and psychosis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Double-chambered right ventricle (DCRV) is a rare form of congenital heart disease. Little is known about the outcome during adult life. Here we report the combined experience of two tertiary Adult Congenital Heart Disease Centres and systematically review the published literature. Results: 50 patients (32 female, median age 39years [IQR: 27;53]) with DCRV under follow-up could be identified. A retrospective review of medical records was performed. Almost all patients (96%) had ventricular septal defects as underlying diagnosis. Eight patients remained completely asymptomatic during follow-up and have been managed conservatively thus far. The remaining patients developed symptoms at a median age of 26years. Surgical correction was performed in 33 patients (median age at operation 27years). No residual intraventricular gradient was present at the latest follow-up in 91% of operated patients and functional class improved significantly with only 6 patients remaining in NYHA class 2. There was no early or late operative mortality and no patient required re-operation for DCRV during a median follow-up of 8years. Conclusions: Contemporary adult DCRV patients have good survival prospects and low long-term morbidity. Despite occasionally presenting with considerable intraventricular gradients we could not identify any case of sudden death in our unoperated adult sub-population. Although asymptomatic adults may be encountered even with severe obstruction, symptom development is common during adult life. Cardiac surgery in this cohort is inherently low risk and offers good long-term haemodynamic and functional results justifying early intervention in consideration of the progressive nature of this rare congenital lesion. [Copyright &y& Elsevier]

Objective: To compare videolaparoscopic nephrectomy and the open technique as treatments for Wilms tumor, specifically the surgical results, immediate and long-term complications, and patient survival. Methods: A review of charts of children with unilateral Wilms tumor was performed. There were 2 surgical groups: (1) only open surgery and (2) videolaparoscopy. Complications, transfusion, ruptures, margins, conversions, lymph nodes, and relapse were analyzed. Results: Seventeen children underwent laparoscopic nephrectomy and 15 underwent open nephrectomy. Mean surgical time was 164.71 ± 26.07 minutes for the laparoscopic group, and there were no conversions or ruptures. The mean specimen weight was 145.01 ± 105.85 g for the laparoscopic group and 257.40 ± 162.70 g for the open surgery group. There was 1 preoperative rupture in the open surgery group. Transfusions were not required in either group. The surgical margins were positive in 1 of 17 cases (5.9%) in the laparoscopic group and in 3 of 15 cases (20%) in the open surgery group. One of the 17 (5.9%) laparoscopy-treated patients and 2 of the 15 open surgery–treated patients (13.3%) presented with local tumor relapse. The 5-year event-free survival rate was 93.3% (95% confidence interval, 0.61-0.99) for the laparoscopic group and 79.6% (95% confidence interval, 0.37-0.95] for the open surgery group (P = .446). Conclusion: Both techniques showed similar immediate and long-term results. [ABSTRACT FROM AUTHOR]

Objective: To assess the determinants of urolithiasis in patients with primary hyperparathyroidism (PHPT) before and after parathyroidectomy (PTX). Methods: Institutional Research Ethics approval was obtained. A retrospective review was performed for patients presenting with PHPT to the stone, surgical oncology, and otolaryngology clinics at 2 tertiary-care centers from January 2006 to November 2011. Demographic, clinical, and surgical data were collected together with 24-hour urine collections before and after PTX. Results: Of 332 patients undergoing PTX, 255 (68.2% female patients) had PHPT. Mean age was 60.3 years (range, 18-91). Before PTX, renal calcification was detected in 51 (20%) patients, nephrolithiasis in 48 (18.8%), and nephrocalcinosis in 3 (1.2%) patients. Compared with PHPT patients without stones, PHPT patients with stones were significantly younger (56.4 vs 61.3 years, P = .02), less likely to be female (54.9% vs 71.9%, P = .03), and had significantly lower levels of vitamin D (19.7 vs 23.5 ng/mL, P = .03). Nine patients (3.5%) developed stones after PTX and were found to have significantly higher post-PTX total serum calcium levels when compared with those without stones. Although hypercalciuria was detected in 62% of pre-PTX stone formers, none of those who tested had post-PTX hypercalciuria (P <.001). On multivariate regression analysis, post-PTX stone formation was associated with male gender (adjusted odds ratio [95% confidence interval]: 6.8 [5.3-7.2], P = .01) and post-PTX hypercalcemia (adjusted odds ratio [95% confidence interval]: 1.48 [1.33-2.12], P = .02). Conclusion: Pre-PTX urolithiasis was associated with younger age, male gender, and lower levels of vitamin D, whereas post-PTX urolithiasis was independently predicted by male gender and hypercalcemia. [Copyright &y& Elsevier]

Highlights: [•] The relevance of HSV-1 in the respiratory tract of ICU patients is unclear. [•] We retrospectively reviewed ICU patients with a positive respiratory HSV-1 culture. [•] Acyclovir treatment was positively linked to in-hospital and ICU-mortality reduction. [•] The group with HSV-1 in the BAL-fluid is the sole contributor to this difference. [•] These results warrant a prospective trial to prove causality. [Copyright &y& Elsevier]

Introduction The use of patient reported outcome measures to support routine inflammatory bowel disease (IBD) care is not widespread and suggests that existing questionnaires lack relevance to day-to-day decisions or are too cumbersome to administer. We developed a simple, generic tool for capturing disease control from the patient's perspective to address these barriers. Methods Development based on literature review, patient focus groups/interviews and a steering group, defining a limited set of generic questions. The 'IBDControl' questionnaire comprises 13 items plus a visual analogue scale (VAS) (0-100). Prospective validation involved baseline completion of IBD-Control, quality of life (QoL) questionnaire (UK-IBD-Q), EuroQol (EQ-5D), Hospital Anxiety and Depression Score; and clinician assessment (blinded to questionnaire; recording Harvey- Bradshaw Index or Simple Clinical Colitis Activity Index; Global Clinician Rating; treatment outcome). Results 299 patients returned baseline surveys (Crohn's disease, n=160; ulcerative colitis, n=139) and 138 attended for repeat visits. Completion time (mean; SD): 1 min 15 s; 25 s; Internal consistency: Cronbach's a for all 13 items (0.85); for subgroup of eight questions ('IBD-Control-8'; 0.86). Strong correlation between IBDControl- 8 and IBD-Control-VAS (r=0.81). Test-retest reliability (2 week repeat): intra-class correlation=0.97 for IBD-Control-8 and 0.96 for IBD-Control-VAS. Construct validity: Moderate-to-strong correlations between IBD-Control-8 and IBD-Control-VAS versus activity indices, UK-IBD-Q and EQ-5D (utility) with r values 0.52-0.86. Discriminant validity (mean instrument scores for remission, mild, moderate or severe): p<0.001 (analysis of variance (ANOVA)). Sensitivity to change: Effect sizes: 0.76-1.44. Conclusions The IBD-Control is a rapid, reliable, valid and sensitive instrument for measuring overall disease control from the patient's perspective. Unlike existing patient reported outcome measures, its simplicity, easeof- use and generic applicability make it a candidate for supporting routine care. [ABSTRACT FROM AUTHOR]

Purpose: Management of squamous cell carcinoma of the penis changed in recent decades in favor of penile sparing surgery. We assessed whether penile sparing therapies were increasingly applied in our penile squamous cell carcinoma cohort with time and whether penile sparing affected 5-year cancer specific survival. Materials and Methods: We reviewed the records of 1,000 patients treated between 1956 and 2012, of whom 859 with invasive tumors were eligible for analysis. Tumors were staged according to the 2009 TNM classification. Binary logistic regression was used to assess penile preservation vs amputation with time. Cancer specific survival was analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards model. Competing risk analysis was done for local recurrence. Results: With time significantly fewer penile amputations were performed. The 5-year cumulative incidence of local recurrence as the first event after penile preservation was 27% (95% CI 23–32) while after (partial) penectomy it was 3.8% (95% CI 2.3–6.2, Gray test p <0.0001). Patients treated with penile preservation showed no significant difference in survival compared to patients treated with (partial) amputation after adjusting for relevant covariables. Factors associated with cancer specific survival were pathological T stage, pathological N stage and lymphovascular invasion on multivariable analysis. In the penile preservation group local recurrence as a time dependent variable in a Cox model was not associated with cancer specific survival (HR 0.52, 95% CI 0.21–1.24, p = 0.13). Conclusions: Significantly more penile preservation therapies were performed in more recent years. Although patients treated with penile preservation experienced more local recurrences, 5-year cancer specific survival was not jeopardized. [Copyright &y& Elsevier]

Purpose: Benign prostatic hyperplasia affects more than 50% of men by age 60 years, and is the cause of millions of dollars in health care expenditure for the treatment of lower urinary tract symptoms and urinary obstruction. Despite the widespread use of medical therapy, there is no universal therapy that treats all men with symptomatic benign prostatic hyperplasia. At least 30% of patients do not respond to medical management and a subset require surgery. Significant advances have been made in understanding the natural history and development of the prostate, such as elucidating the role of the enzyme 5?-reductase type 2, and advances in genomics and biomarker discovery offer the potential for a more targeted approach to therapy. We review the current understanding of benign prostatic hyperplasia progression as well as the key genes and signaling pathways implicated in the process such as 5?-reductase. We also explore the potential of biomarker screening and gene specific therapies as tools to risk stratify patients with benign prostatic hyperplasia and identify those with symptomatic or medically resistant forms. Materials and Methods: A PubMed® literature search of current and past peer reviewed literature on prostate development, lower urinary tract symptoms, benign prostatic hyperplasia pathogenesis, targeted therapy, biomarkers, epigenetics, 5?-reductase type 2 and personalized medicine was performed. An additional Google Scholar™ search was conducted to broaden the scope of the review. Relevant reviews and original research articles were examined, as were their cited references, and a synopsis of original data was generated with the goal of informing the practicing urologist of these advances and their implications. Results: Benign prostatic hyperplasia is associated with a state of hyperplasia of the stromal and epithelial compartments, with 5?-reductase type 2 and androgen signaling having key roles in the development and maintenance of the prostate. Chronic inflammation, multiple growth factor and hormonal signaling pathways, and medical comorbidities have complex roles in prostate tissue homeostasis as well as its evolution into the clinical state of benign prostatic hyperplasia. Resistance to medical therapy with finasteride may occur through silencing of the 5?-reductase type 2 gene by DNA methylation, leading to a state in which 30% of adult prostates do not express 5?-reductase type 2. Novel biomarkers such as single nucleotide polymorphisms may be used to risk stratify patients with symptomatic benign prostatic hyperplasia and identify those at risk for progression or failure of medical therapy. Several inhibitors of the androgen receptor and other signaling pathways have recently been identified which appear to attenuate benign prostatic hyperplasia progression and may offer alternative targets for medical therapy. Conclusions: Progressive worsening of lower urinary tract symptoms and bladder outlet obstruction secondary to benign prostatic hyperplasia is the result of multiple pathways including androgen receptor signaling, proinflammatory cytokines and growth factor signals. New techniques in genomics, proteomics and epigenetics have led to the discovery of aberrant signaling pathways, novel biomarkers, DNA methylation signatures and potential gene specific targets. As personalized medicine continues to develop, the ability to risk stratify patients with symptomatic benign prostatic hyperplasia, identify those at higher risk for progression, and seek alternative therapies for those in whom conventional options are likely to fail will become the standard of targeted therapy. [ABSTRACT FROM AUTHOR]

Introduction. Osteoporosis is recognized by the World Health Organization as a disease associated with the progress of civilization, also called the 'epidemic of the 21st century'. Objective. An attempt to portray the level of knowledge and health behaviours of societies of selected countries of the world in the prevention of osteoporosis, based on available studies. Materials and method. Theoretical concepts and reviews of current published studies. Results. Accessible study findings conducted worldwide are not exhaustive and often present the subject in a fragmentary way. Data presented in the presented article shows that knowledge of osteoporosis among the Polish population and the population of selected countries of the world appears insufficient in the issues associated with its prophylaxis and prevention; they also testify to a disregard and lack of application of the principles of a healthier lifestyle in daily life regarding this still little-known illness. Since the number of people threatened with osteoporosis, as well as the number of bone fractures, is, constantly rising, versatile action should be undertaken aimed at preventing falling ill and progression of the disease. Conclusions. After reviewing the literature, it was realized that few researchers have been interested in the issue of osteoporosis. This fact is proved by an insufficient amount of publications dealing with the subject and the problem associated with osteoporosis from the point of view of the public. The findings of presented study show that most often the subject is not portrayed as a whole, but concerns only selected preventive behaviours or learning about some risk factors. [ABSTRACT FROM AUTHOR]